Value-based lean implementation in a surgical unit: the impact of the methodology

Abstract

PurposeThis paper aims to present a method for strategic planning and implementation processes in health care based on lean management.Design/methodology/approachWithin the framework of the action research methodology, the authors present the ten steps of a kaizen project, which enable lean transformation over a period of time. The study is underpinned by a literature review of enablers and barriers and an implementation case in a tertiary care hospital.FindingsKey points and possible contingency issues are presented for each of the steps, and a successful lean tools intervention is illustrated by examples of improvement projects of the surgical process. Conclusions of the implementation establish a roadmap for improvement projects in hospital environments based on lean management, thus bridging the existing gap between the large number of theoretical projects (much of the projects described are not sustainable over time as the hospital sector is very particular) that have failed to be implemented, or been paused mid-term, and the self-sustaining projects developed by improvement teams in the hospital.Originality/valueThe study details knowledge gleaned from a three-year project entailing various stages: forming improvement teams; training health-care professionals in lean management; drawing up a process map to identify value stream mapping improvement opportunities; implanting projects and verifying the results obtained; and finally, laying the cornerstones, which would make the project self-sustaining and open to long-term continuous improvement.

A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center

“…Following the principles of the Lean philosophy [47,48] and using action research methodology [18], this section presents a scientific methodology as shown in Figure 1 below that allows the redesign of processes and that can be replicated with the same purpose in other health centers in order to improve patient care. Previous research similar to this paper [18] suggests that there are not many references in the health care field to the action research approach [49][50][51]; it is a sector more focused on case studies.…”

“…The main disadvantage is that it assumes that each process takes a long time to complete, which is not always the case. The main purpose of using action research is to seek the participation and involvement of the researcher as an agent of change along with the other members of the organization because, in the health sector, managing change requires the participation of the entire team involved in the processes identified for improvement [49]. This will allow the knowledge acquired to have a cyclical effect, which in turn will allow further improvement and sharing of that improvement with other organizations and researchers [18].…”

Improving performance of the hospitalization process by applying the principles of Lean Thinking

“…Today, the service industry, especially the hospitals have been wise to adapt to Lean transformation by applying similar Lean techniques to their processes (Yu et al , 2021; Ahn et al , 2021). Lean is an approach which improves healthcare service quality by eliminating faults and decreasing patient waiting times through effective use of available resources (Graban, 2011; Godley and Jenkins, 2019; Sales and De Castro, 2021). Many authors have implemented Lean applications in healthcare through case studies confirming the validity of the methodology (Chiarini, 2014; Jorma et al , 2016; Yurtkuran et al , 2017; Sánchez et al , 2018; Bharsakade et al , 2021).…”

Aplicação do Mapeamento de Fluxo de Valor e Lean Healthcare na emergência de um hospital de referência regional

“…Tem sido usado com sucesso em diferentes aplicações de saúde, desde pequenas clínicas médicas (Lummus et al, 2006;Rocha & Vasconcelos, 2021) até sistemas mais complexos, como departamentos de emergência, unidades cirúrgicas (Sales & De Castro, 2021). No entanto, os profissionais devem estar cientes de algumas distinções importantes entre manufatura e saúde ao aplicar MFV (Doğan & Unutulmaz, 2016).…”